| المساهمون: |
PEGASO Registry Group, [Martínez-Sellés,M] Servicio de Cardiología, Hospital General Universitario Gregorio Marañón. Universidad Europea de Madrid, Madrid, Spain. [Gómez Doblas,JJ] Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. [Carro Hevia,A] Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain. [García de la Villa,B] Servicio de Cardiología, Hospital de Manacor, Mallorca, Spain. [Ferreira-González,I] Unidad de Epidemiología del Servicio de Cardiología, Hospital Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP) y Universitat Autónoma de Barcelona, Spain. [Alonso Tello,A] Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. [Andión Ogando,R] Servicio de Cardiología, Hospital Clínico Universitario, Valladolid, Spain. [Ripoll Vera,T] Servicio de Cardiología, Fundación Hospital Son Llatzer, Palma de Mallorca, Spain. [Arribas Jiménez,A] Servicio de Cardiología, Hospital Clínico Universitario, Salamanca, Spain. [Carrillo,P, López-Palop,R] Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Spain. [Rodríguez Pascual] Servicio de Geriatría, Complejo Hospitalario Universitario do Meixoeiro, Vigo, Spain. [Casares i Romeva,M] Servicio de Cardiología, Hospital Plató, Barcelona, Spain. [Borras,X] Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. [Cornide,L] Servicio de Medicina Interna, Hospital del Sureste, Arganda del Rey, Spain., This work was supported by funds from the NCI Breast SPORE program Grant No. P50-CA58223-09A1 (CMP), by RO1-CA138255 (CMP), by the Breast Cancer Research Foundation (CMP and MJE), National Cancer Institute (NCI) Strategic Partnering to Evaluate Cancer Signatures Grant No. U01 CA114722-01 (MJE), by the Sociedad Española de Oncología Médica (AP), by FEDER (RETICC-RD12/0036/0051, RD12/0036/0042, RD12/0036/0076, RD12/0036/0070), by Instituto de Salud Carlos III—PI13/01718 (AP), by Banco Bilbao Vizcaya Argentaria (BBVA) Foundation (AP) and by the Alliance Statistics and Data Center (U10-CA33601 |
| الوصف: |
OBJECTIVE: To study the factors associated with choice of therapy and prognosis in octogenarians with severe symptomatic aortic stenosis (AS). STUDY DESIGN: Prospective, observational, multicenter registry. Centralized follow-up included survival status and, if possible, mode of death and Katz index. SETTING: Transnational registry in Spain. SUBJECTS: We included 928 patients aged ≥80 years with severe symptomatic AS. INTERVENTIONS: Aortic-valve replacement (AVR), transcatheter aortic-valve implantation (TAVI) or conservative therapy. MAIN OUTCOME MEASURES: All-cause death. RESULTS: Mean age was 84.2 ± 3.5 years, and only 49.0% were independent (Katz index A). The most frequent planned management was conservative therapy in 423 (46%) patients, followed by TAVI in 261 (28%) and AVR in 244 (26%). The main reason against recommending AVR in 684 patients was high surgical risk [322 (47.1%)], other medical motives [193 (28.2%)], patient refusal [134 (19.6%)] and family refusal in the case of incompetent patients [35 (5.1%)]. The mean time from treatment decision to AVR was 4.8 ± 4.6 months and to TAVI 2.1 ± 3.2 months, P < 0.001. During follow-up (11.2-38.9 months), 357 patients (38.5%) died. Survival rates at 6, 12, 18 and 24 months were 81.8%, 72.6%, 64.1% and 57.3%, respectively. Planned intervention, adjusted for multiple propensity score, was associated with lower mortality when compared with planned conservative treatment: TAVI Hazard ratio (HR) 0.68 (95% confidence interval [CI] 0.49-0.93; P = 0.016) and AVR HR 0.56 (95% CI 0.39-0.8; P = 0.002). CONCLUSION: Octogenarians with symptomatic severe AS are frequently managed conservatively. Planned conservative management is associated with a poor prognosis. |